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Obese Patients' Weight Is The 800-Pound Gorilla In The Examining Room

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Weight is an emotional issue for most people, and doctors need to be sensitive when they talk about it with their patients, researchers say. Heavyset people don't want their physicians using terms like ''obesity'' or ''fatness,'' the researcher's new study shows.

The findings come at a time when medical professionals across the country are being encouraged to help heavyset patients lose weight for health reasons. But often neither doctors nor patients will bring up the subject.

University of Pennsylvania researchers had 324 women and men who were at least 50 pounds over a healthy weight fill out questionnaires. They were told this: ''Imagine you are visiting your doctor for a checkup. The nurse has measured your weight and found that you are at least 50 pounds over your recommended weight. The doctor will be in shortly to speak with you.''

Then the doctor walks in and says, ''Good morning, I want to talk about your . . . ''

Participants were asked to rate the words and phrases the doctor might use to address those extra pounds. Terms like ''fatness'' and ''obesity'' are hurtful and offensive to people because of the ''pejorative connotations in everyday use,'' says Thomas Wadden, director of the Weight and Eating Disorders Program at the University of Pennsylvania School of Medicine.

If doctors use those descriptions, they could turn patients off and bring an abrupt halt to a much-needed discussion on the problem, he says. The word ''weight' is non-judgmental.

''Doctors and patients are in stalemate when it comes to weight management. They don't talk about it,'' Wadden says.

Surveys show that 50% of physicians don't raise the problem with their overweight or obese patients, and patients don't talk about it either. ''Obese individuals don't bring the topic up because they are ashamed and embarrassed,'' he says. ''And doctors don't bring it up for fear of hurting patients' feelings or because they feel weight control efforts are futile. It's time to end the stalemate.''

Another study in the same journal shows that even those who treat and study obesity sometimes stereotype the heavyset.

Almost 400 health professionals took a test and filled out a questionnaire that measured bias. The results revealed that the doctors associate obese people with being lazy, stupid, worthless and bad, says Marlene Schwartz, a researcher in the psychology department at Yale. Younger health professionals show greater bias.

The doctors have a lower level of bias than the general population, she says. But the fact that they also stereotype overweight people ''points to how pervasive and powerful the societal stigma is.''

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